Episode 34: Is it perimenopause ... or something else?

Is it perimenopause or something else? 5 conditions every midlife woman should know about 

Host Lynda Enright explains that symptoms often blamed on perimenopause - exhaustion, brain fog, weight gain, mood changes, feeling cold, and hair loss - may be caused by other overlooked, treatable conditions. Using a client story, she shows how perimenopause can coexist with hypothyroidism and low ferritin, creating overlapping symptoms and missed diagnoses. The episode covers five look-alike issues: thyroid dysfunction (request a comprehensive panel beyond TSH, including free T3, free T4, and thyroid antibodies), iron deficiency/low ferritin (often missed when hemoglobin/hematocrit are normal), insulin resistance (check fasting insulin and A1C, not just fasting glucose), burnout/HPA axis dysregulation, and perimenopause itself. Lynda emphasizes thorough investigation, the possibility of multiple causes at once, and highlights ferritin as the key lab test many doctors skip.

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Transcript

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Today we are talking about something I see constantly in my practice. Women who have been living with exhaustion, brain fog, weight gain, mood changes, and they've just been told it's menopause, it's perimenopause. But here's what I want you to consider. It, it might not be only perimenopause. Yes, it's true; maybe it's that time of life. You expect that that's probably what's happening. But there may be something else going on, or maybe several things that maybe are being completely overlooked because we're just blaming it on menopause. By the end of this episode, you'll know five conditions that have symptoms that look similar to perimenopause and menopause, and you will know exactly what kind of testing helps so you can tell the difference. And I promise if you stay with me until the end, I will share one lab test that many doctors skip, and it could be a key to unlocking why you feel so drained. So let's jump in. Menopause doesn't have to feel like you are living in someone else's body. Your host, Lynda Enright, has spent the last 25 years helping women to thrive in midlife. Here you'll find science-based practical advice that you can start using today to get real results for your health. Welcome to Joyful Menopause. Today's episode is one I have wanted to record for a long time because this is one of the patterns I see very often in my practice, and it can be a really frustrating thing that a woman experiences. You go to your doctor, you tell them your symptoms, and you're told, "You're probably perimenopausal." And then you leave without answers, without a plan, without anyone actually looking deeper. So I want to change that for you today and help you understand what to do, what to ask for. So let me first tell you about a woman I'll call Sandra. She came to me. She was 46. She was exhausted. Not the kind of tired that I just need to get a good night's sleep, but the bone-deep, can't function kind of tired. She had gained about 15 pounds over the previous couple years despite, you know, really limiting what she was eating and trying to exercise regularly. She was always cold when everyone else was fine. Her hair was falling out. She could see it in the shower drain. Her brush was full of hair every day. She was struggling to get through workouts that used to not be a problem. She felt depressed. She felt disconnected from herself. She'd been to her primary care doctor. She had told them all of this, and she'd been told, "You're probably just perimenopausal. It's a tough time. These are some of the symptoms." She was given a prescription for antidepressants and sent on her way. That was two years before she came to me. When we sat down and we went through her full history and then we looked at some of the lab data and got some new labs, something very clear emerged. She, she was in perimenopause, and we expected that and we know that, but she also had hypothyroidism that had not been looked at. Her ferritin, her iron storage, was really low. And again, she wa- was in perimenopause. Three things, three separate, distinct, treatable things all presenting with a lot of the same symptoms. So no wonder she felt terrible. No wonder nothing that she'd been doing had helped. She'd been trying to treat one thing, and she was actually dealing with three things. So her story is not unusual. It's honestly something I hear all the time, and that's exactly why I want you to understand what these five overlapping conditions are. So let's start with the first one. The first one is thyroid dysfunction. Your thyroid gland sits at the base of your throat. It controls your metabolism, your energy production, your body temperature, your mood, and even hair growth. So when it slows down, called hypothyroidism, the symptoms are a lot of things that women experience in perimenopause. Fatigue, weight gain, brain fog, depression, feeling cold, dry skin, hair thinning, constipation. Sound familiar? Here's the critical thing I want you to understand about thyroid testing. The standard test that a lot of doctors order is called TSH or thyroid-stimulating hormone. It's a good starting point for sure, but it doesn't give you the full picture. It's sort of a predictor of what's going on, but it's not necessarily the whole story. So I always want to see free T3, free T4, and thyroid antibodies. Why is that? Because you can have a completely normal TSH and also normal-- there's a big range for, for normal TSH, so you can be somewhere in that range, and you still might have thyroid that is not converting to those active hormones that are actually doing the job. Or possibly those hormones are being attacked by your, your immune system, or your thyroid is being attacked by your immune system, and so you're simply not... your cells are not getting what they need. So if you have been told your thyroid is fine, but you still feel exhausted and cold and foggy and your hair is falling out, I want to just gently encourage you to ask for a more complete comprehensive thyroid panel. That's what you're looking for. Number two condition, iron deficiency and low ferritin. This one is missed a lot, and it frustrates me because it's really a simple test, and it's really impactful if you treat it. Most doctors will check hemoglobin and hematocrit when they screen for iron deficiency, and those tests are looking for full-blown anemia, iron deficiency anemia. But ferritin is your iron storage protein, and that's a separate measure, and it tells you some things that those, those tests just aren't telling you. You can have normal hemoglobin, and you can still have ferritin that is so low that your cells are literally starving for oxygen. And imagine if your cells are starving for oxyge- oxygen, you feel tired. You need oxygen in your cells. So the symptoms are crushing fatigue, brain fog, heart palpitations, shortness of breath, d- not tolerating exercise very well, getting more tired than you used to, hair loss. Restless legs at night can be a, a symptom. So here's again, what makes this particularly relevant for women in perimenopause is that a lot of women in their 40s might still be getting a regular period, but their cycles maybe have become more heavy or more frequent. And that means you could be losing more blood every month than before, silently draining your iron stores, and your hemoglobin again still might look normal on a standard blood panel. So checking ferritin is really important. Ideally, I want to see it above about 70. A lot of women I see, you know, they might even be like 12, 15, 20, and even, you know, could be in a normal range, but functionally you are dealing with symptoms. You're not feeling good. Number three, condition three is insulin resistance. Insulin resistance is when your cells stop responding efficiently to insulin. Insulin is the hormone that moves glucose from your bloodstream into your cells, so they have energy, so your cells have the fuel that they need. So when this happens, glucose and insulin stay elevated, and your body then starts to store more fat, particularly abdominal fat. The symptoms of this insulin resistance can be weight gain, weight gain that doesn't always make a lot of sense, especially belly fat; maybe energy crashes, particularly after meals; cravings, intense cravings- potentially carbohydrates, sugar in particular; brain fog; mood swings; disrupting your sleep. So why this is so important to catch in midlife at this time as our hormones are starting to change, because estrogen plays a role in keeping your cells insulin sensitive. So as you're starting to see an estrogen decline during perimenopause, insulin resistance can develop or it can get worse. So these two condition-- you know, the two situations now can feed each other and, and really, um, magnify the problem. The tests I look for, fasting insulin and hemoglobin A1C. So a standard fasting blood sugar test alone doesn't catch early stage insulin resistance. You can have completely normal fasting glucose and still have elevated fasting insulin, which means that your pancreas is working overtime. It's working so hard to compensate, and then that's a signal that tells us that we, we can do something about this now and get on top of it before it gets to be a, a more significant problem Number four, burnout and HPA axis dysregulation. So HPA axis, hypothalamic pituitary adrenal axis. I've talked about this before. It's a mouthful. I want to talk about this one because I think it gets dismissed as just stress in a way that doesn't honor how physiological, physiological this actually is. This is just your body doing what it's supposed to do. Your HPA axis is your body's central nervous system response, your central stress response, I should say. So when you've been under significant chronic stress for months, maybe years, this system, this, this nervous system central stress response gets dysregulated. So now your cortisol patterns shift. You might feel wired at night and exhausted in the morning. You might wake up at 3:00 AM with your mind racing. You might feel overwhelmed by things that used to feel manageable. You might feel sort of flat emotionally, like you just, you just don't have the excitement maybe that you used to. You just don't have a buffer left for the, the stress that your body's under. So the biological piece that's so important is estrogen helps to buffer the stress response in your brain. It modulates how sensitive you are to the signals of stress, the stressors in your body. So as estrogen declines in perimenopause, your brain becomes more reactive to stressors. So the woman who spent 20 years managing a demanding career, teenagers, aging parents, a household without blinking, honestly, may suddenly find that that same load is just overwhelming. That is not weakness. That is a change in your actual biology, your neurochemistry. Burnout is usually distinguished by history, years of high demand, chronic under-fueling, maybe not getting enough nourishment, poor sleep, unrelenting caregiving- again, a sandwich generation, kids and parents- with no time to recover from it all. And the great thing about this is this responds really wonderful to good nutrition and lifestyle support when we figure out what's going on. And number five, perimenopause. I want to be clear, perimenopause is real, it's significant, and it does cause meaningful symptoms. Irregular cycles, hot flashes, night sweats, disrupted sleep, mood changes, brain fog, changes in libido, joint discomfort. These are all part of the perimenopause experience, and they deserve attention, and they deserve care. They do not deserve to be dismissed. But my observation a- after doing this work for 25 years, is that so many women who come to me are not just dealing with perimenopause: they're dealing with perimenopause plus one or two of these other things that are going on, these conditions that I've already talked about. And when you only look at perimenopause or you get dismissed completely, when we have thyroid dysfunction or low ferritin, ferritin or insulin resistance, those are still maybe simmering in the background, so you might get a little bit of results, but you're not going to feel 100% back to normal because you haven't addressed all of these foundational pieces. So this is why, you know, we don't guess: we investigate, we do lab tests, we figure out what's really going on. So let me give you four things to carry with you from today. First, just because you're in your 40s, your 50s, and you feel terrible, doesn't mean it's simply perimenopause or menopause. Symptoms can overlap, and you deserve a thorough investigation, not a dismissal. Number two, the standard labs that your doctor ri- might run might not be enough. Ferritin, fasting insulin, free T3, free T4, and thyroid antibodies are tests I want to see, and often they are skipped. Third, you absolutely can have more than one thing going on at the same time. In fact, you know, more often my experience is that is often what's happening. And fourth, the-- all these things are treatable. When you know what you're dealing with, you can do something about it. There is absolutely hope. So now I want to talk about the gap between where you might be right now, maybe exhausted, confused, feeling frustrated, and where you actually want to be. You want to feel like yourself. You want to have your energy back. You want your brain to work. You want to understand what is happening in your body and have a plan that actually makes sense for you specifically. The challenge is that without knowing what is driving your symptoms, m- many times the approach that you're trying is just guessing, and guessing is exhausting when you've been doing it for years. So this is the kind of work that I do with women in my practice. We don't just guess. We test if needed. We gather the lab data from the doctor. We analyze that data. We build a personalized plan that's based on what your body actually needs, not what works for women in general, but what works and what is needed for you. If you're ready to stop guessing and start getting real answers, I invite you to schedule a free discovery call, call with me. You can go to bewellconsulting.com/schedule-a-call. It's in the, in the comments below as well. We'll have a conversation about what you're experiencing, what you've already tried, and whether working together is a good fit. There's no pressure. It's just a conversation. But it might be the conversation that could change everything. Again, that is at bewellconsulting.com. As I promised, I have one more thing for you before I let you go. The one lab test that most doctors skip and why it matters so much for midlife women. That is ferritin. That's it. One test. It's an easy test. Most doctors screen for iron deficiency by checking hemoglobin and hematocrit, and if those come back normal, they tell you your iron is fine. And also, like I said, a lot of times in perimenopause, your period might be getting heavier, but sometimes even if you're not getting a regular period, you might be low in f- stored iron, in ferritin. So it's really important to measure. And, and it's again, a completely different measurement than just hemoglobin. You can be walking around with a really low ferritin, 10, 12, 15, feeling completely wiped out, losing your hair, struggling to get through a workout, and be told by your doctor that your blood work looks great. So asking specifically for ferritin, write it down, ferritin, F-E-R-R-I-T-I-N. The ideal level for most women is somewhere... Ideal is kind of 70 to 100 maybe. Below 30 most practitioners would treat. But I've seen women that, you know, once they get up to those oc- optimal levels to a functional level, they get more energy, their hair improves, they work out, their mood improves. So that number can really give you a lot of information. Thank you so much for being here today. If this episode was helpful, please share it, because too many women are wi- walking around with unanswered questions, not knowing what to ask and what to do next about it, and you and they absolutely deserve better. I will see you next time on the Joyful Menopause Podcast.